The combination of stricture dilation, endoscopic needle aspiration, and biliary brushings significantly improves diagnostic yield from malignant bile duct strictures

• Published in: Gastrointestinal endoscopy Vol. 54; no. 5; pp. 587 - 594
• Main Authors: Farrell, Richard J., Jain, Ajay K., Brandwein, Steven L., Wang, Helen, Chuttani, Ram, Pleskow, Douglas K.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-11-2001; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biliary Tract Neoplasms - diagnosis; Biliary Tract Neoplasms - pathology; Biological and medical sciences; Biopsy, Needle - instrumentation; Biopsy, Needle - methods; Catheterization; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis - diagnosis; Cholestasis - etiology; Cytodiagnosis - instrumentation; Cytodiagnosis - methods; Digestive system. Abdomen; Endoscopy; Female; Gallbladder Neoplasms - diagnosis; Gallbladder Neoplasms - pathology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - pathology; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Human; Biliary tract; Carcinoma; Aspiration; Cytology; Instrumentation therapy; Brushing; Instrumental dilatation; Malignant tumor; Striction; Biliary tract disease; Improvement; Association; Fine needle; Digestive diseases; Diagnosis; Endoscopy
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1067/mge.2001.118715

Background: Brush cytology, routinely performed at ERCP to assess malignant-appearing biliary strictures, is limited by relatively low sensitivity and negative predictive value. This study assessed whether the combination of stricture dilation, endoscopic needle aspiration, and biliary brushing improves diagnostic yield.
Methods: In a prospective nonrandomized study, 46 consecutive patients were evaluated with malignant-appearing biliary strictures at ERCP. Twenty-four patients (Group A) underwent standard brush cytology alone and 22 patients (Group B) underwent stricture dilatation to 10F, endoscopic needle aspiration, and subsequent biliary brushing by using the Howell biliary system. The diagnostic yields for both techniques were compared.
Results: Of the 46 patients, 34 had proven malignant strictures (14 Group A, 20 Group B). Compared with brushing alone, the combination of stricture dilatation, endoscopic needle aspiration, and subsequent biliary brushing significantly increased both the sensitivity (57% vs. 85%,
p < 0.02) and specificity (80% vs. 100%,
p < 0.02) of cytology with positive brushings in all patients with pancreatic or gallbladder carcinoma.
Conclusions: The combination of stricture dilation, endoscopic needle aspiration, and biliary brushing significantly improves diagnostic yield for malignant bile duct strictures and may particularly be of benefit for extrinsic strictures caused by pancreatic or gallbladder carcinoma. (Gastrointest Endosc 2001;54:587-94.)